Potential for fraudulent use of digital radiography

Background. Digital radiographic images can be manipulated using personal computers. To test the potential for fraudulent use, the authors altered a series of dental radiographs, printed them to simulate duplicated films and submitted them for authorization of proposed treatment. Materials and Methods. The authors obtained periapical radiographs of teeth that contained small restorations or were unrestored from the files of three dental patients at a private dental practice. The authors used a flatbed scanner to digitize and import the radiographs into a computer. Then they added dental caries, large restorations, fractures and periapical pathosis to the radiographs. The authors proposed to the insurance companies that the teeth in question be restored using expensive treatment, such as root-canal therapy and full-coverage crowns. Results. In each case, the insurance companies authorized the proposed treatment based on the appearance of the teeth on the radiographs. The altered images illustrated an apparent need for dental treatment that was not required and that could have led to payment for treatment that was not actually performed. Conclusions. This study illustrates the potential for the fraudulent use of manipulated digital radiographic images. Clinical Implications. Dentistry should be aware of the implications of the potential for such abuse and should develop measures both to prevent it from occurring and to facilitate its detection.